Curb High Cholesterol

It’s no secret that high cholesterol can put you at a higher risk for cardiovascular disease (heart attacks and strokes). And even though unhealthy cholesterol levels can almost always be kept in check with some common-sense lifestyle changes, most of us don’t have a clue how to apply these smart strategies to our own lives. As a result, the number of Americans with high cholesterol levels is skyrocketing.

Currently, an estimated 107 million American adults have total blood cholesterol values in the “borderline high risk” range of 200 milligrams per deciliter (mg/dL) and higher, according to the American Heart Association. Of these, about 37.7 million people have levels of 240 or above — the level at which most doctors whip out the prescription pad for one of the cholesterol-lowering statin drugs, despite these drugs’ list of nasty side effects, which can include fatigue, muscle weakness, liver damage and possibly even ocular hemorrhage.

These drugs aren’t just reserved for people at high risk. Recently, an international team of researchers said that anyone who smokes, is overweight or obese, has diabetes or suffers from high blood pressure should be a candidate for statin drugs. Other scientists have gone even further, saying that everyone older than 55 should be taking cholesterol-lowering drugs, whether or not they have elevated cholesterol levels. But should any of these factors mean an automatic ticket to statin land? Most alternative health practitioners say no and offer a host of safe, natural ways to bring cholesterol levels back down into a healthy range.

Bad Versus Good

Despite its bad reputation, cholesterol actually plays an important role in health. We need cholesterol to build and maintain cell membranes; for the production of sex hormones; to aid in the manufacture of bile (which helps digest fats); and to convert sunshine to vitamin D. Cholesterol also is important for the metabolism of fat-soluble vitamins, including vitamins A, D, E and K. Cholesterol is produced by the body and is also obtained through diet (mainly from animal foods and some tropical oils high in saturated fats). The trouble begins when we have too much of the wrong type of cholesterol.

Essentially, there are two types of cholesterol. Low-density lipoprotein (LDL) is the so-called “bad” cholesterol because it carries cholesterol into the arteries, where it sticks to arterial walls and contributes to plaque build-up. According to recent evidence uncovered by researchers at Michigan State University, this layer of plaque can then crystallize, expand and burst, sending the plaque shooting into the bloodstream. This chain of events kick-starts the body’s natural clotting process, essentially shutting down the artery.

High-density lipoprotein (HDL) is known as the “good” cholesterol. HDL keeps track of LDL levels, moving the excess to the liver where it is reused, converted to bile acids or excreted out of the body. The goal is to keep your LDL levels low and your HDL levels high. According to the government’s National Cholesterol Education Program, that means striving for an optimal LDL level below 100 mg/dL and an HDL level above 60 mg/dL. Total cholesterol levels — the sum of all the cholesterol in your body — should ideally be below 200 mg/dL.

The Scoop on Statins

Doctors often rely on statin drugs to lower unhealthy cholesterol levels. These drugs work by blocking an enzyme called HMG-CoA reductase, which triggers the production of LDL cholesterol in the liver. Numerous studies show that these drugs are highly effective at lowering both LDL and total cholesterol levels. But statins also have a dark side. It seems that the same enzymes involved in the production of cholesterol are also required for the production of Coenzyme Q10 (CoQ10). Not surprisingly, lower cholesterol levels in statin users are accompanied by a depletion of CoQ10. CoQ10 plays an important role in providing energy to the cells, especially in the heart — and low levels are implicated in virtually all cardiovascular diseases, including angina, hypertension, cardiomyopathy and congestive heart failure.

In addition to the long list of statins’ potential side effects, researchers at the University of Pittsburgh report that one of these drugs, lovastatin, could affect attention and reaction speed. In their study, patients whose cholesterol had been lowered with lovastatin paid less attention and had delayed psychomotor reflexes compared with those who had not received the drug. Those who had the greatest decreases in cholesterol levels suffered the greatest impairment.

But the most serious problem with statin drugs is rhabdomyolysis, a life-threatening condition that destroys muscle cells, releases them into the bloodstream and eventually can cause kidney failure. Rhabdomyolysis gained national attention when it was linked to Baycol, the statin drug that was pulled from the market in 2001 after causing more than 100 deaths and 1,600 injuries.

Eat Away High Cholesterol

Fortunately, a number of safe, effective ways to slash your cholesterol don’t require statin drugs. First and foremost is adopting a healthy diet. While the American Heart Association and National Cholesterol Education Program traditionally have recommended eating a low-fat diet, researchers from the University of Toronto devised an even more effective diet that revolves around specific cholesterol-lowering foods, like fiber-rich fruits and vegetables, soy protein, oats and nuts. Dubbed the Portfolio Eating Plan, the diet also includes three servings of psyllium (Plantago spp.) per day and supplemental plant sterols with chemical structures similar to cholesterol that can help block food-based cholesterol from being absorbed into the bloodstream.

The Portfolio diet has been shown to lower total and LDL cholesterol levels up to 30 percent. One recent study of 46 adults with high cholesterol pitted the plan against 20 mg of the prescription drug lovastatin and found that both were equally effective for lowering cholesterol levels, but the plan had no side effects.

Adding exercise to the equation can help lower cholesterol even more. In one study review, Canadian researchers at McGill University found that combining a cholesterol-lowering diet with moderate exercise not only lowers total and LDL cholesterol, it also raises HDL levels. Another study conducted at Dong-A University in Korea found the same effect in older women participating in a long-term aerobic exercise program. Even walking can have a beneficial impact on your lipid levels, say Dutch researchers who discovered that walking briskly for 30 minutes five days a week not only lowered cholesterol, it actually added three years to the participants’ life expectancies.

Smart Supplements

Although eating right and exercising can have a huge impact on your cholesterol levels, they are admittedly hard to stick to every day. Because of this, many people turn to the following supplements as complements to their heart-healthy lifestyle changes.

Coenzyme Q10. A few years ago, the International Journal of Cardiology published the results of a double-blind trial that tested the effects of CoQ10 on 47 patients who either had suffered a heart attack or had been diagnosed with angina. Twenty-five of the patients received 60 mg of CoQ10 twice a day, while everyone else got a placebo. In less than a month, those on the enzyme had a 22.6 percent decrease in lipoprotein(a), a protein compound that carries cholesterol in the blood. LDL also dropped, as did oxidative stress. At the same time, CoQ10 gave HDL a significant boost. None of these effects were seen in the participants taking the placebo.

Fish oil. The omega-3 fatty acids in fish oil supplements help transport cho- lesterol out of the body. And fish oil is especially effective when combined with garlic. In one trial by Canadian scientists, 50 men with high cholesterol received either a combination of 1,200 mg of fish oil with 900 mg of garlic, fish oil alone, garlic alone or a placebo. Those taking the garlic-fish oil combination had a 34.3 percent reduction in their LDL levels and a 12.2 percent decrease in their total cholesterol. But to reap the cholesterol-lowering benefits of fish oil, you need to take at least 3,000 mg a day.

Policosanol. This is the generic name for a mixture of alcohols derived from sugarcane, which can lower the production of cholesterol to more favorable levels. Policosanol also enhances our bodies’ ability to remove and process LDL cholesterol. In one study, a team of German scientists reviewed lipid-lowering trials using policosanol and found that, at doses of 10 to 20 mg a day, policosanol lowers total cholesterol by 17 to 21 percent and LDL cholesterol by 21 to 29 percent. Better yet, policosanol raises HDL cholesterol by 8 to 15 percent — more than statin drugs. A direct comparison with statin drugs also showed that 10 mg policosanol was just as effective as the same amount of the statin drug atorvastatin. But, unlike statins, which become increasingly toxic with higher doses, policosanol achieves its maximum effect at very low doses (10 mg), and taking more is neither more effective nor more toxic.

Heart-Healthy Herbs

Herbs also can help control your lipid levels. Although a number of herbs can boost heart health, studies show that the herbs below are especially effective at tackling stubborn cholesterol:

Arjuna (Terminalia arjuna). This traditional Ayurvedic herb is a potent antioxidant and at least one study has shown that it outperforms vitamin E in reducing cholesterol. After dividing 105 patients into three groups, researchers from Monliek Hospital and Research Centre in Jaipur, India, measured the effects of arjuna, vitamin E or a placebo on cholesterol. No changes were seen in the vitamin E and placebo groups. However, those taking the arjuna had a 12.7 percent decrease in total cholesterol and a 25.6 percent reduction in LDL. According to the researchers, these results were achieved with a daily dose of 500 mg of arjuna.

Fenugreek (Trigonella foenum-graecum). Fenugreek seeds contain compounds known as steroidal saponins that inhibit both cholesterol absorption in the intestines and cholesterol production by the liver. Multiple human trials have found that fenugreek may help lower total cholesterol in people with moderate atherosclerosis or those with diabetes. A small preliminary trial involving 18 men and women with high cholesterol found that taking 25,000 to 50,000 mg of fenugreek powder daily significantly lowered serum cholesterol after 20 days. Although these amounts are extremely high, you may see results with a more modest dose of 5,000 mg taken with each meal.

When to Get Checked

The sooner you know what your cholesterol levels are, the sooner you can take action to correct an unhealthy profile. Everyone older than 20 should have their cholesterol levels checked every five years. Once you’ve passed your 50th birthday, get your cholesterol tested annually.

Garlic (Allium sativum). Dozen of studies show that this pungent herb can help lower cholesterol in people with mildly to moderately raised levels. In one double-blind clinical trial, an aged garlic extract lowered total cholesterol 7 percent and LDL levels dropped 10 percent compared with a placebo. Other studies show that garlic raises HDL levels. This antioxidant-rich herb also helps reduce blood pressure in people suffering from hypertension, making it a wonderful all-around heart herb. Although you can lower your cholesterol by chewing one or two whole cloves of raw garlic daily, most people prefer taking 600 to 900 mg of odorless, enteric-coated tablets or capsules each day in divided doses. Look for a supplement containing 1.3 percent of the active ingredient allin for best results. If you cook with garlic, reducing cooking time will best preserve garlic’s beneficial compounds.

Guggul (Commiphora mukul). This resin from the mukul myrrh tree is a staple in Ayurvedic medicine because of its ability to lower cholesterol and treat atherosclerosis. Guggul works by interacting with the receptor — called the Farnesoid X receptor (FXR) — that regulates cholesterol metabolism. When bile acids reach a certain level in the body, FXR kicks in to stop the metamorphosis of cholesterol to bile acids. Guggul blocks this action so that more cholesterol is converted to bile acid, effectively reducing serum cholesterol levels. Human studies show that guggul lowers both total and LDL cholesterol while slightly raising HDL levels. If you opt for guggul, look for a supplement that contains 75 mg of guggulsterones (the cholesterol-lowering compounds in guggul).

Red yeast rice (Monascus purpureus). The spice that gives Peking duck its distinctive red color also can lower cholesterol. Red yeast rice accomplishes this by restricting the liver’s production of cholesterol — not surprising since the compound responsible for this effect is chemically identical to the statin drug lovastatin. Scientists at the University of California, Los Angeles Center for Human Nutrition studied a proprietary red yeast rice supplement in a 12-week double blind, placebo-controlled trial involving 83 adults with borderline-high to moderately elevated cholesterol. They found that the supplement significantly reduced both total and LDL cholesterol levels. Other studies show that red yeast rice safely lowers total cholesterol an average of 10 to 30 percent, LDL cholesterol an average of 10 to 20 percent and increases HDL by 7 to 15 percent.

As with statin drugs, red yeast rice can deplete CoQ10 levels, so make sure to supplement with at least 30 mg of CoQ10 daily if you use this supplement. Although relatively free from side effects, some people experience digestive upset when taking a red yeast rice extract. To avoid this, take the supplement with food. Red yeast rice is a statin, albeit a natural one. In high doses or taken over long periods of time, it can cause liver damage — periodic monitoring of liver enzymes is recommended. It also carries the rare risk of developing rhabdomyolysis. It should not be taken by anyone who is on prescription statins or who has liver disease.

Kim Erickson is the author of Drop-Dead Gorgeous: Protecting Yourself from the Hidden Dangers of Cosmetics (Contemporary Books, 2002) and a frequent contributor to Herbs for Health.